Provider Demographics
NPI:1114297116
Name:CELINA MEMORIAL CLINIC INC
Entity Type:Organization
Organization Name:CELINA MEMORIAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:LOVELINE
Authorized Official - Last Name:OBIDIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-757-0104
Mailing Address - Street 1:6746 WINDY RIVER LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6344
Mailing Address - Country:US
Mailing Address - Phone:281-717-4805
Mailing Address - Fax:832-262-4640
Practice Address - Street 1:6746 WINDY RIVER LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6344
Practice Address - Country:US
Practice Address - Phone:281-717-4805
Practice Address - Fax:832-262-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801530292261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center